Equality, Diversity & Inclusion Monitoring Form (EQUALITY ACT 2010)
KENNEDY SCOTT
(To be completed by KS job applicant)
We ask all applicantsto complete and return this EDI Monitoring Form to support our commitment towards equal opportunities, diversity and inclusion.When used during the recruitment process it is separated from your application and is not seen by the selection panel. This information will play no part in the selection process.It will be used to compile statistics for monitoring purposes and will be treated in the strictest confidence.
Unique ID (office use) / DOB / (DD/MM/YYYY)I do not wish to disclose
Job Role Applied For / Support Staff (Administrator/IT/Assistant)
Delivery Staff (ACM/EC/Advisor/Tutor)
Management (BM/Senior/Quality/Performance)
SMT (Directors/Regional Management/Operations/HR) / Based in Centre/s
ETHNIC GROUPI do not wish to disclose
White
British (23)
Irish (24)
Other White (25) / Mixed
White & Asian (19)
White & BlackAfrican (20)
White & Black Caribbean (21)
Other Mixed (22) / Asian/Asian British
Bangladeshi (11)
Indian (12)
Pakistani (13)
Other Asian (14) / Black/Black British
Black African (15)
Black Caribbean (16)
Other Black (17) / Other Group
Chinese (18)
Other (98)
Not Known (99)
MARITAL STATUS GROUPI do not wish to disclose
Single Married Civil Partnership Living with Partner Divorced Widowed
Other:
DEPENDANT’S RESPONSIBILITIES(i.e. children or other relatives)I do not wish to disclose
Yes No
DISABILITY/HEALTH PROBLEMSI do not wish to disclose
Do you consider yourself to have a disability as defined under the Equality Act 2010 Yes No
If you have answered ‘yes’ to the above question then please indicate which category best describes your disability:
Physical Learning Difficulty Mental Health Sensory Other:(Please state)
In your opinion, are there any changes or adjustments that Kennedy Scott could make to your physical working environment that you feel would help you in the workplace?
Please give details:
SEXUAL ORIENTATIONI do not wish to disclose
BisexualGay ManGay Woman/LesbianHeterosexualOther:
RELIGION/BELIEF I do not wish to disclose
Atheism Buddhism Catholicism Christianity Hinduism Islam Judaism
Sikhism Other (Please state)
GENDER I do not wish to disclose
MaleFemaleI consider myself to be transgender
Data Protection Act 1998
Your personal details will be treated as confidential and kept for no longer than necessary.If your application is successful, your Application and Monitoring Forms will become part of your personal records.Some of the information may be held on a computer database.
Please indicate that you consent to Kennedy Scott processing the data supplied in this form: Yes No
Equality Act 2010
This form was created in line with all current regulations
HRQ DMF-APage 1 of 1Version 1 (05/15)